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NPI Code Detail

MEDICARE: DR. JILL G BRYANT MD

MEDICARE: DR. JILL G BRYANT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician043375GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CG6045OTHERGARAILROAD MEDICARE GROUP ID
31306820741OTHERGAMEDICARE NPI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306820741
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL G BRYANT MD
Provider Business Mailing Address
First Line : 711 KNIGHT AVE
Second Line :
City : WAYCROSS
State : GA
Zip : 31501-1943
Country : US
Telephone Number : 912-283-9423
Fax Number : 912-283-8204
Provider Business Practice Location Address
First Line : 711 KNIGHT AVE
Second Line :
City : WAYCROSS
State : GA
Zip : 31501-1943
Country : US
Telephone Number : 912-283-9423
Fax Number : 912-283-8204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 11/17/2020

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Directions to “ DR. JILL G BRYANT MD” Practice Location

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